Radionuclide Shuntography for the Evaluation of Ventriculo-Peritoneal Shunt in Children with Hydrocephalus

Background: Radionuclide shuntography is a safe, simple and non-invasive functional imaging technique for determining ventriculo-peritoneal (V-P) shunts tube patency with minimal radiation exposure. This is particularly useful in children with hydrocephalus in whom V-P shunt is inserted to divert CSF drainage. V-P shunts are, in many cases, permanent treatment option for children with hydrocephalus and radionuclide shuntography is becoming a very popular technique because of the increasing numbers and survival of children with shunt-treated hydrocephalus. Objective: The aim of this study is to document the usefulness of shuntography in the evaluation of V-P shunt in patients with hydrocephalus. Materials and Methods: All shuntograms performed in our institution from 2008 to 2015 were included in this study. Radionuclide shuntography was performed with Tc-99m DPTA injected into the shunt reservoir and images acquired using a dual headed MEDISO camera. A normal shuntogram is considered as free flow of radiotracer (Tc-99m DTPA) from site of injection to the distal end of shunt tube and spillage into the peritoneum. Results: A total of 56 children were studied comprising of 32 males and 24 females with age ranges of 5month to 11years. Different patterns of results were found, normal functioning shunt tube, partial block shunt tube due to infection or inflammatory debris and total blocked shunt tube due to mechanical defects. Conclusion: About 52% of our patients had partial blockage of their shunt tube. Patients who are diagnosed with a partial tube blockage will require only flushing of the tube and antibiotics treatment, while mechanically blocked tube will require shunt revision. This distinction is critical considering the cost of replacement of V-P shunt tube and the manpower time for surgery. There was no mortality or morbidity associated with radionuclide shuntography in our patients.